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Remote electrical neuromodulation offers a non-invasive, low-risk alternative to medication in pediatric migraine management.
A recent pilot study in ‘HEADACHE-The Journal of Head and Face Pain’ explored the feasibility and acceptability of remote electrical neuromodulation (REN) as a treatment modality for youth experiencing migraines in the emergency department (ED). The study by Serena Laura Orr et al. aimed to compare REN to standard intravenous (IV) treatments, such as Metoclopramide and also examined which trial design—parallel-group or crossover—was more effective in recruiting participants.
The randomized double-dummy trial enrolled 19 youth participants, aged 8 to 17, who presented to the ED with migraine. The two intervention arms included active REN stimulation along with matched normal saline placebo IV, and a typical care group receiving matched sham REN stimulation along with IV Metoclopramide and Ketorolac. The primary focus of the trial was on evaluating trial feasibility and acceptability, while secondary data gathered preliminary insights into the efficacy and safety of REN.
The recruitment process was notably higher during the parallel-group phase, with 36% of eligible participants enrolled compared to 28% in the crossover phase. Positive feedback was received from both participants and clinical staff regarding the trial protocol. Youth in the study reported greater interest in using REN for future ED visits compared to traditional IV treatments. Specifically, the average interest score for REN use was 3.7 out of 5, compared to 2.8 for IV treatments.
As for pain relief, both REN and typical care showed reductions in pain severity, with the REN group reporting a mean pain decrease of 2.1 points on an 11-point numerical rating scale (NRS) at one hour, and 2.4 points at two hours. The typical care group showed slightly higher reductions, with a mean decrease of 2.9 points at one hour and 4.0 points at two hours. Only one participant in the typical care group experienced an adverse event, while none were reported in the REN group, suggesting that REN may have a comparable safety profile.
While the preliminary findings indicate that REN could be a viable alternative to standard migraine treatments in the ED, the study acknowledges the need for further, larger-scale trials to fully assess REN’s effectiveness and safety in this setting.
HEADACHE-The Journal of Head and Face Pain
Remote electrical neuromodulation to treat children and adolescents with migraine in the emergency department: A randomized double-dummy pilot trial
Serena Laura Orr et al.
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